胸腔镜与开胸手术治疗非小细胞肺癌对机体创伤的比较

Comparation of video-assisted thoracoscopic surgery and open-chest operation on surgery trauma

目的 比较胸腔镜与传统开胸手术行肺叶切除术治疗非小细胞肺癌对患者机体创伤及围手术期恢复情况的影响.方法 选取2010年4月-2011年4月行手术治疗的非小细胞肺癌患者86例.根据手术方式不同分为传统开胸手术组（OT）和胸腔镜组（VATS）.通过随机表法将患者分为OT组43例和VATS组43例,通过比较两组患者术前1d晨问、术后第1天晨间、术后第2天晨间、术后第3天晨间、术后第7天晨间静脉血清中皮质醇（Cor）、生长激素（GH）、三碘甲状腺原氨酸（T3）、四碘甲状腺原氨酸（T4）、C-反应蛋白（CRP）水平,探讨两种入路手术治疗非小细胞肺癌对患者机体创伤的影响.并且通过比较两组患者手术时间、淋巴结清扫数、术后胸腔闭式引流管放置时间、术后住院时间、术后并发症,探讨两种手术方式在治疗效果、围手术期恢复情况方面的差异.结果 相同级别术式（肺叶切除术）的两组患者术前血清Cor、GH、T3、T4、CRP水平差异均无统计学意义（OT组vs VATS组：67.58 vs 68.04；1.30 vs 1.31；1.21 vs 1.23；84.39 vs 84.43；8.20 vs 8.17,P值：0.370,0.251,0.322,0.470,0.146）.而VATS组术后1d、2d、3d、7d血清Cor、GH、T3、T4、CRP水平低于OT组,差异均有明显统计学意义（P＜0.01）.两组患者接受手术时间（OT组vs VATS组：3.08 vs 3.90,P＜0.01）、术后住院时间（OT组 vs VATS组：7.49vs 6.26,P＜0.01）；差异均有统计学意义；淋巴结清扫数（OT组vs VATS组：25.00 vs 26.12,P=0.477）、术后引流管放置时间（OT组 vs VATS组：4.06 vs 3.91,P=0.508）、术后并发症发病率（OT组 vs VATS组：20.9 vs 18.6,P=0.787）,差异均无统计学意义.结论 在根治性和安全性基本一致的情况下,与传统开胸手术相比,胸腔镜手术具有手术创伤应激减轻、术后早期康复快等明显优势,可作为早期非小细胞肺癌的推荐治疗方式.

Objective By means of control test,to compare the surgical trauma and perioperative recovery between video-assisted thoracoscopic surgery（VATS） and conventional thoracotony for lobectomy.Methods Eightysix non-small cell lung cancer patients who had undergone operations from April 2010 to April 2011 were chosen.According to operative mcthods,the patients were divided into two groups：video-assisted thoracoscopic surgery group（VATS） and open chest group（OT）.The protein and hormone level of serum Cortisol（Cor）,growth hormone （GH）,triiodothyronine （T3）,tetraiodothyronine （T4）,C-reactive protein （CRP） were selected as indexes to investigate the surgical trauma on non-small cell lung cancer patients.The duration of operation,quantity of lymph node dissection,chest tube duration,postoperative hospital stay,postoperative complications were chosen as indexes to measure operation result and perioperative recovery.Results Under the condition that patients undergone the same operation level（lobectomy ＋ Systemic lymph node dissection）,there was no ststistical significance in preoperative level of serum Cor,GH,T3,T4,CRP.The postoperative concentrations of serum Cor,GH,T3,T4,CRP on the 1 d,2 d,3 d and 7 d were lower in VATS group,and there were obvious statistical significance（P ＜0.01）.And there were obvious statistical significance in duration of operation （P ＜ 0.01）,postoperative hospital stay（P ＜ 0.01）,quantity of lymph node dissection （P =0.477）.There were no obvious statistical significance in chest tube duration （P =0.508）,postoperative complications （P =0.787）.Conclusions VATS lobectomy is able to achieve a same result for radical treatment outcone and safety to routine open chest lobectomy in patients.Compared witt routine open chest lobectomy,VATS lobectomy has less surgical trauma,much rapid recovery,it should be recommended for patients with non-small cell lung cancer.